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Objectives: The COVID-19 pandemic disrupted many facets of healthcare including patients delaying medical care for potentially life-threatening conditions. This study sought to compare specific key outcomes related to ischemic stroke that occurred before and during the COVID-19 pandemic. We assessed mortality rates, morbidity rates, and the administration of thrombolytics in patients with ischemic stroke admitted to emergency departments (ED) in the Stroke Belt, a region of the United States with historically worse stroke outcomes. Method(s): Cerner Real-World Data was used to identify patients residing in the Stroke Belt (Southeastern United States) who were admitted to the ED with ICD-10 codes indicating acute ischemic stroke. We determined in-hospital and 30-day mortality rates, morbidity rates (physical disability tracked 1-year post-ischemic stroke), and administration of thrombolytics for acute ischemic stroke patients before the COVID-19 pandemic (March 2019-February 2020) and during the pandemic (March 2020-February 2021). Result(s): In the defined period prior to COVID-19, 2,338 patients presented to the ED with ischemic strokes (49.5% male;mean age 64.8, SD:15.23;69.6% white). During COVID-19, 2,052 ischemic stroke patients presented to the ED (50.9% male;mean age 65.8, SD:15.04;71.5% white). Our analyses show a significant decrease in thrombolytic administration during the pandemic compared to before the pandemic (12.2% and 14.5%, respectively;p<0.05). There was no significant difference in rates of in-hospital mortality, 30-day mortality, or morbidity following ischemic strokes. Conclusion(s): The findings of our study suggest a reduction in ischemic stroke related ED encounters during the COVID-19 period, but no differences were observed in mortality and morbidity rates in ischemic stroke compared to before the pandemic. Future studies are required to determine if these trends were true in other regions of the United States, as well as to investigate other potential covariates linked to outcomes before and during the COVID-19 pandemic.Copyright © 2023
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The objective of this research was to map the profile of scientific production on the internationalization strategy of small and medium-sized enterprises (SMEs), both nationally and internationally, from 2012 to 2021, through a bibliometric study with a quantitative approach, with with the intention of presenting a comparative analysis and identifying how Brazil is compared to other countries. The Scopus database (CAPES) was used, plus the VOSviewer tool. Internationalization is an important and complex achievement for companies and has become a widely studied topic in the field of SMEs;however, Brazil has little prominence. This study presents a broad view of thematic publications, allowing a current investigation of their transmission in scientific productions, aiming to fill the gap observed in the literature, especially that produced in Brazil. The results meant that exploratory, qualitative research and case studies were predominant, and that publications on the subject of research grew, with 2020 being the peak of publications, in view of the Covid-19 pandemic, which cause negative economic and financial impacts, mainly on SMEs, thus arousing greater interest for the researcher. Despite the growing interest in the subject in the period surveyed, Brazil had only 1.8% of the publications. Note in the research that there is a predominance of good Qualis concepts (A1 and A2). It was also noticed that the co-citation network among the 10 most cited authors revealed a thematic, methodological and/or conceptual proximity between them, revealing lines of thought or seminal research that influenced the other authors of the researched journals. Finally, this research aims to serve as a stimulus for future work related to and/or involving this topic that is so important for small and medium-sized organizations, in addition to being able to serve as a source for further research, mainly in Brazil.
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This paper, part of a research, aims to analyze the revenues and expenses paid with tax revenue from the minimum percentage of taxes in the context of the Covid-19 pandemic, in the fiscal year 2020, in the 13 municipal governments of Regiao Serrana of Rio de Janeiro State. For the investi-gation, has been compiled documents on the sites of the Audit Court of the State of Rio de Janeiro, the Public Prosecutor's Office of the State of Rio de Janeiro, and the Transparency Portal of Mu-nicipalities for data collection, systematization, and analysis. The results showed, among other find-ings, that 13 municipal governments spent more than R$ 11 million on illegal and undue expenses. Moreover, only five municipal governments used education revenue to fund out-of-school education.
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Objetivos: Descrever a experiencia de membros de uma liga academica de hematologia na realizacao das atividades de extensao apos dois anos da pandemia de COVID-19. Metodologia: Trata-se de um relato de experiencia que tem como base a vivencia deacademicos da Universidade Estadual de Feira de Santana na realizacao de atividades de extensaopresenciais e virtuais, de fevereiro a junho de 2022. Descricao da experiencia: As atividades de extensao estritamente presenciais, queestavam suspensas desde marco de 2020 e reiniciaram em fevereiro de 2022, compreenderam oatendimento no ambulatorio de hematologia e o acompanhamento da orientadora da liga academicano atendimento portadores de neoplasias hematologicas na unidade de alta complexidade emoncologia (UNACON). Alem do contato concreto com pacientes, essas experiencias possibilitaram adiscussao dos casos junto a orientadora e aos internos do curso de medicina que atendem tambem noambulatorio. As acoes realizadas presencialmente com pacientes contaram com a utilizacao de Equipamentos de Protecao Individual (EPI), considerando o contexto da pandemia de COVID-19.Ainda nesse contexto, todos os ligantes apresentaram comprovante de esquema vacinal completocontra o SARS-CoV-2. Alem disso, em carater virtual, foi realizada uma campanha para sensibilizacaoa doacao de sangue durante o junho vermelho, que constou numa serie de 3 publicacoes nas redessociais da liga sobre os requisitos e contraindicacoes para doar, incluindo um video em que os ligantesabordaram os mitos e verdades envolvendo o processo. Todas as atividades foram organizadas erealizadas integralmente pelos membros ativos da liga, o que estimulou o compromisso dosgraduandos com as tarefas e o envolvimento destes entre si. Discussao: As metodologias de educacao em modalidade virtual foram implementadas pelasinstituicoes de ensino superior desde o inicio da pandemia de COVID-19, como solucao para acontinuidade do ensino nas universidades. Entretanto, as estrategias adotadas nao foram capazes desolucionar plenamente as demandas: um dos limites do metodo virtual compreende a realizacao deatividades de extensao dentro das unidades de saude. A retomada dessas atividades e de grandeimportancia para a formacao academica por completo, uma vez que os projetos de extensao permitemao discente explorar e desenvolver suas habilidades, integrando a teoria a pratica, o que possibilita aconstrucao de novos conhecimentos e a troca de saberes. Em se tratando de academicos de medicina,os beneficios encerram a preparacao para o enfrentamento de eventuais pandemias e demais situacoesemergenciais no futuro e a manutencao do atendimento a populacao que utiliza os servicos de saude. Conclusao: Assim, depreende-se que as atividades de extensao dentro da liga academica,sobretudo as presenciais, sao de enorme valia, de modo que possibilitam integracao e contribuem paraa formacao de qualidade do graduando de medicina. Percebe-se que a retomada dessas atividades foirealizada sob seguranca e permitiu a ampliacao da atuacao da liga na sociedade. Copyright © 2022
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Background: Obesity, which is becoming increasingly common worldwide, is known to be associated with cardiovascular disease and progression of chronic kidney disease, due to inappropriate activation of the renin-angiotensin system. Many angiotensin II effects are dependent on AT1 stimulation of reactive oxygen species (ROS). In COVID-19 patients, overweight and obesity are associated with acute respiratory distress syndrome and AKI. Although obesity increases oxidative stress, endothelial dysfunction and inflammation, its effect on IRI-induced AKI is unknown. We hypothesized that obesity would aggravate renal IRI in mice. Method(s): We fed mice a high-fat or standard diet (45 and 10 kcal% fat, respectively) for 8 weeks. Some then underwent bilateral 30-min clamping of the kidney hila and subsequent reperfusion (groups: obese, normal, obese+IRI and normal+IRI). All studies were performed 48 h after IRI. Data are mean+/-SEM. Result(s): Body weight (g) was 33+/-1.7, 32+/-0.7, 27+/-1.4 and 26+/-0.9 in the obese, obese+IRI, normal and normal+IRI groups, respectively (P<0.001). Mortality was 42% and 25% in the obese+IRI and normal+IRI groups, respectively (P <0.05);there were no deaths in the non-IRI groups. Serum glucose and cholesterol did not differ among the groups. Creatinine clearance (mL/min/100g BW) was 0.20+/-0.05 and 0.20+/-0.07 in the obese+IRI and normal+IRI groups, respectively, vs. 0.34+/-0.06 and 0.40+/-0.08 in the obese and normal groups, respectively. Renal p65 protein expression (%) was 127+/-4.8 in the obese+IRI group, vs. 100+/-4.1, 92.5+/-4.8 and 107+/-3.7, respectively, in the normal, obese and normal+IRI groups (P<0.05). Conclusion(s): In obese individuals with AKI, ROS could be a therapeutic target (FAPESP, NWO).
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ObjectiveDigital health (DH) is the integration of technologies to tackle challenges in healthcare. Its applications include mobile health, remote & wireless healthcare, artificial intelligence, and robotics. Digital technologies are increasingly being used to deliver routine care, whilst simultaneously patients are increasing their uptake of DH solutions (e.g. wearables).With the adoption of DH increasing across the NHS, there is a growing need for a digitally literate workforce. However, there are no national standards on DH education for UK medical students. Consequently, this study sought to assess the current provisions, perceptions and challenges regarding DH education in the undergraduate medical curriculum.MethodsAn anonymous cross-sectional online survey was developed following a literature search and by collecting iterative feedback from both researchers and external collaborators. The survey consisted of questions in 6 areas: (a) understanding of DH;(b) existing provision of DH education;(c) interest in DH education;(d) preferred means of delivering and assessing DH education;(e) impact of the COVID-19 pandemic on DH;and (f) demographic information.The survey was administered via Qualtrics from March to October 2021, and disseminated to UK medical students via university mailing lists, social media and student representatives. Quantitative and qualitative data were collected pertaining to demographics, attitudes, preferences, and current provisions regarding DH education. Qualitative responses underwent thematic analysis. For quantitative analysis, R (version 3.5.0) and R Studio (version 1.1a) were used.Results514 complete responses were received from 39 UK medical schools in 2021. 57.2% of respondents were female, with a mean age of 22.9 ± 3.2. 65.8% of students considered DH ‘extremely important’ to future clinical practice, particularly the domains of electronic patient records, telehealth and smartphone applications. However, only 18.1% felt aware of the DH competencies required in clinical medicine. 70.2% of students reported receiving some DH education, with the highest proportion being in the form of lectures or seminars (30.5%, n=157), e-learning modules (28.6%, n=147) and ad hoc teaching during clinical placements (22.8%, n=117). However, only 25.7% felt satisfied with these provisions. Themes for student satisfaction related to a practical teaching approach, delivery of content appropriate for their training stage and coverage of topics in student interest. Conversely, student dissatisfaction originated from inadequate teaching, and subsequent fears of falling behind. 56.1% preferred DH education to be mandatory rather than elective, ideally through hands-on workshops (75.8%) and lectures and seminars (60.4%). 65.4% thought DH proficiency should be assessed in some capacity, of which 75.6% preferred formative assessment.ConclusionThis study represents the first national survey of UK medical students on DH education. Overwhelmingly, the results indicate that medical students recognise the significance of DH and would appreciate better formal integration into their curriculum;which is supported by previous similar studies in the literature. This study also identified how students would prefer to be taught and assessed on DH, in particular that they would prefer it be mandatory yet remain formative at present. Given the increasing ubiquity of DH in clinical practice, it is therefore crucial that universities and wider medical education organisations work to improve and standardise DH education, to better prepare medical students to adapt to the continuously developing digital landscape. This rings especially true in light of the recent COVID-19 pandemic which has highlighted the quintessential nature of DH to medical practice. Our intended future research from this study includes undergraduate focus groups for greater qualitative depth of information, and Delphi panels from wider medical education stakeholders into what should be included in DH education, with the eventual goal of devel ping a comprehensive and standardised national DH curriculum.
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Several actions were deployed to contain the propagation of the new coronavirus and the flattening of the contagion curve, or rather, social distancing with partial or total suspension of commercial activities, including agricultural fairs. Current research identifies the effects of the pandemic on production and commercialization by family farmers in the Project of Sustainable Development Porto Seguro in Marabá PA Brazil. Study comprised field research and the application of a questionnaire with questions on the farmer´s profile, characteristics of activities and impacts by the pandemic. Data from qualitative and quantitative approaches were tabulated and interpreted by descriptive analysis. Results showed a production increase by farmers and changes in sanitary practices. However, trade decreased and prices remained stable, impairing family income. Emergency help was important for income supplementation. Farmers had at their disposal TV, radio and WhatsApp for information, even though access to the Internet was not without difficulties. According to the interviewees, the pandemic´s main negative items were lockouts, difficulties in selling, impairment of health and loss of products. Positive items comprised on-line agricultural fair, a new solution for reaching clients. © 2022 University Center of Maringa. All rights reserved.
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The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020 led to a significant change in human behaviors, mainly because of the quarantine to avoid the spread of the virus. Measures affected both economic activities and citizens' behaviors as they developed more intense hygiene habits to avoid contamination and switched to home offices. These exceptional behaviors also affected the way that water is consumed and need to be fully understood to manage supply systems. Therefore, this study aims to investigate changes in residential and commercial water consumption in 31 municipalities in the state of São Paulo, Brazil, during SARS-CoV-2. To do this, the expected consumption for the first half of 2020 was forecasted using the Holt-Winters multiplicative method and compared with the data observed for the same period. In addition, we compared monthly records of new contaminations and the social distancing index to establish a correlation with changes in water consumption. The results show an average difference between forecasted and observed consumption equal to +6.23% and -18.59% for residential and commercial activities, respectively. For the first one, the consumption per capita increased at the rate of 8.44 L.person-1.day-1. The observed changes in consumption seem to be a consequence of hygiene habits, social distancing and the closing of nonessential services in commerce. © 2022 American Society of Civil Engineers.
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Background: Arthritis by Paracoccidioides brasiliensis is a remarkably unusual etiology of infectious joint disease. While osseous lesions can be present in systemic disease, intra-articular-restricted disease without typical lung or lymph node involvement is mostly anecdotal1,2. Objectives: We hereby describe a case of this fungal arthritis in a patient with rheumatoid arthritis (RA) without signifcant immunosuppression. Methods: Patient records review. Written informed consent was obtained. Results: A 65-year-old female Brazilian patient with a 35-year history of seropositive RA complained of a painful knee edema for the last three weeks. Skin surrounding the joint was erythematous, warm, and tender to the touch, which initially raised the suspicion of cellulitis. She had already received a 10-day course of amoxicillin-clavulanate, with no improvement. C-reactive protein was 17.8 mg/L, rest of blood chemistry panel was within reference range. Point-of-care ultrasound revealed joint effusion, and a diagnostic arthrocentesis was performed. Synovial fluid was slightly turbid, with 10,100 cells per mm3, of which 80% were lymphocytes. Cultures for bacteria and mycobacteria yielded negative results, but culture for fungi detected growth of P. brasiliensis. The patient had been solely on prednisone 5 mg once daily for the last year, given that, due to covid-19 pandemics, she lost regular follow-up and abandoned treatment with immunosuppressants. Aside from mild RA-related interstitial lung disease, she had no other comorbidity. She denied local trauma to the knee, which made hematogenous dissemination of the fungi the most probable source. Comprehensive work-up to search for organic involvement of paracoccid-ioidomycosis, including chest computed tomography and transthoracic echocardiogram, did not evidence any visceral compromise. Voricona-zole 200mg t.i.d. was started, with good response. Three months after the beginning of the azole, tofacitinib was started for moderate RA disease activity, which also responded satisfactorily. Repeat arthrocentesis and synovial biopsy were performed eight months after the start of antifun-gal treatment, the former being normal (770 cells per mm3, negative cultures), and the later only demonstrating non-specific chronic synovitis with fibrosis. Conclusion: We reported an exceedingly rare presentation of P. brasiliensis infection with exclusive joint involvement.
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Objective: To analyze how COVID-19 contingency plans adopted in Brazilian state capitals and in the Federal District approach the health protection of Primary Health Care (PHC) workers.
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Objetivo: Correlacionar as internações hospitalares por embolia e trombose arteriais com as infecções por SARS-Cov-2 no Brasil, através da lista de morbidade do CID-10 (CID 10 - I74) no período de maio de 2020 a maio de 2021. Materiais e métodos: Estudo epidemiológico, descritivo e retrospectivo, de análise quantitativa, cuja fonte de dados foi o Sistema de Morbidade Hospitalar (SIH-SUS) do Ministério da Saúde, tabulados em gráficos e tabelas no programa Microsoft Excel 2016. Resultados: Entre maio de 2020 e maio de 2021 foram observadas 24.971 internações por embolia e tromboses arteriais, sendo que 23.209 (93%) foi em caráter de urgência. Já entre maio de 2019 e abril de 2020 o número de internações foi de 20.706, valor que entre maio de 2018 e abril de 2019 foi de 20.400. Discussão: A infecção por SARS-Cov-2 em pacientes que desenvolvem a forma grave da Covid-19 é associado ao maior risco de formação de coágulos e, consequentemente, de embolias e tromboses. Uma das principais teorias para explicar a associação entre Covid-19 e coagulopatias é que o estado de hiperinflamação provoca uma desregulação nos eventos trombóticos. Desse modo, o aumento de 12% no número de internações por embolia e trombose arteriais observados entre maio de 2020 e maio de 2021 quando comparado ao período de maio de 2019 a abril de 2020 pode ter sido causado pela pandemia da Covid-19 iniciada em março de 2020. Além disso, uma análise retrospectiva mostra que esse aumento foi o maior em números absolutos nos últimos cinco anos. Conclusão: É possível notar o aumento do número de casos de embolias e tromboses arteriais no contexto pandêmico, corroborando com os estudos que associam a Covid-19 com os distúrbios da coagulação.
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Objetivos: Avaliar a efetividade e eficiência de um protocolo de descontinuação de inibidores de tirosina quinase (ITK) em tratamento no Sistema Único de Saúde (SUS) que incluiu uma fase de descalonamento de dose antes da interrupção do tratamento. Materiais e métodos: Estudo prospectivo, em andamento. Critérios de inclusão: LMC em fase crônica, em tratamento com ITK no mínimo há 3 anos, transcritos BCR-ABL típicos, com resposta molecular profunda (RMP) por 2 anos (MR4.5) Exclusão: fase avançada prévia ou atual, resistência prévia, mutações do ABL. Antes da suspensão do tratamento, foi realizado o descalonamento do ITK para 50% da dose atual por 6 meses. Durante a fase de descalonamento foi realizado monitoramento de PCR quantitativo para BCR-ABL (PCRq) mensal. Após a descontinuação do ITK o paciente foi seguido com avaliações clínicas, hemograma e PCRq a cada 4 semanas no primeiro semestre, a cada 2 meses no segundo semestre e no segundo ano e depois a cada 3 meses. A terapia foi reiniciada na perda de RMM (PCRq<0.1%). Resultados: Entre setembro de 2020 e julho de 2021 foram triados 213 pacientes com LMC;28 eram potencialmente elegíveis: 9 não aceitaram participar;19 assinaram o TCLE e um paciente teve falha de screening. A mediana de idade dos 18 participantes foi de 61.5 anos (35-86), 61% homens, 44.4% Sokal baixo risco ao diagnóstico, 15.1% intermediário/alto;81% com transcrito BCR-ABL do tipo b3a2;78% estavam em uso de Imatinibe,11% Dasatinibe,5.5% Nilotinibe e 5.5% Bosutinibe. A mediana da duração do tratamento com ITK até o início do descalonamento foi de 136 meses (46-201);a duração da RM 4.5 foi de 104, 5 meses (27-168);a mediana do tempo entre suspensão e perda de RMM foi de 2.5 meses (2-3). Oito pacientes perderam a RM4.5 durante a fase de descalonamento: destes, 2 perderam RMM, um na fase de descalonamento e outro na fase de descontinuação. Status atual: sete pacientes estão na fase de descontinuação, 8 na fase de descalonamento e 3 pacientes (16.6%) apresentaram recaída molecular. Não houve nenhum evento adverso sério. Dois pacientes tiveram Covid-19 (leve) na fase de descalonamento. Discussão: a descontinuação tem sido proposta como estratégia terapêutica na prática clínica nos pacientes com LMC com RM profunda sustentada. Nesses casos, a chance de sobrevida livre de remissão é de 50%. Poucos estudos avaliaram o efeito da retirada gradual do ITK antes da interrupção. No estudo DESTINY, o descalonamento foi feito por 12 meses, e a sobrevida livre de terapia aos 36 meses foi de 72% nos pacientes com RM4.0. Nos resultados preliminares do nosso estudo, ainda em recrutamento de pacientes, com 10 meses de seguimento, observamos que das 3 recaídas, uma delas ocorreu na fase de descalonamento, em um paciente em uso de nilotinibe em segunda linha e outra em um paciente na segunda tentativa de descontinuação, onde é esperado uma menor chance de sucesso. Conclusões: até o momento o protocolo mostrou-se seguro, com resultados dentro do esperado na literatura. O seguimento a longo prazo e inclusão de novos pacientes nos permitirá avaliar se a estratégia do descalonamento trará vantagem na sobrevida livre de terapia.
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Background. Brazillian authorities reported a total of 16.3 million cases and 454. 000 deaths during COVID-19 pandemic in Brazil by may 2021. It became necessary to educate healthcare professionals on diagnosis and treatment of the syndrome. Game based learning surfaced as an effective alternative, since it promotes critical thinking and problem solving skills. A team of Brazilian and Peruvian students, physicians, designers and programmers gathered to create a decision based computer game that simulates a hospital scenario and allows medical students to analise, make decisions and receive feedback. This work describes the creative process and showcase the initial version of the software. Methods. Professors and students of Medicine, Information Technology (IT), Design and Architecture from Brazil and Peru assembled a team in order to develop the computer game. Clinical cases were created by the medical students and professors, comprising medical procedures for the treatment and management of COVID 19, and a video game script was developed exploring gamification principles of challenge, objectivity, persistence, failure, reward and feedback. Algorithms (image 1) were created, under supervision of professors of Medicine, to define possible courses of action and outcomes (e.g. gain or loss of points, improvement or worsening of the patient). Students of Design created artistic elements, and IT students programmed with a game engine software. This fluxogram, written in portuguese, describes in detail all the possible courses of actions that can be exercised by the player. It is created by a team of Professors of Medicine and medical students, in accordance with evidence-based guidelines. Primarily, this document guides the programmers and designers throughout the development phase of the game. Results. Initially, an expandable minimum viable product was obtained. The game, visualized on image 2, consists in a non-playable character and a playable character (i.e. doctor), with a scenario and a dialogue script simulating a clinical examination of a COVID 19 patient. The player can interact with certain elements within the game, e.g. the computer and other characters, to retrieve test results or start dialogues with relevant information. Hospital scenario and dialogue window between doctor (player in black) and patient (non playable character) are displayer in the game engine software (Unity 2D). On the bottom half of the screen, the dialogue box allows the player to collect the patient's medical history. The player can interact with certain elements to obtain relevant information to make decision and progress in the game. Conclusion. The game allows medical students to practice diagnosis and treatment of COVID 19. Future versions will include assessment reports of player's actions, and a new score system will be implemented. New diseases will be incorporated in the gameplay to match the variety of scenarios offered by real hospitals and patients. Artificial intelligence will be employed to optimize gameplay, feedback and learning.
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Purpose: This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. Design/methodology/approach: The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. Findings: This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA;and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM;46.5% and 91.5% for IgG;and 59.1% and 77.3% for combined tests. Originality/value: The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals;however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups. © 2022, Emerald Publishing Limited.
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Introduction Healthcare workers (HCW) have been reported to be at high risk for several mental health problems due to occupational stress. The outbreak of COVID-19 pandemic in early 2020 raised new concerns about the mental health of HCW workers, which may be affected by new demands and the organization of work. Studies comparing pre-and post-pandemic work environments in health settings are necessary to evaluate the effect of the pandemic on HCWs mental health. Objectives We aimed to investigate the association between occupation stress and depressive symptoms among HCW in a city in northeastern Brazil at the end of 2019, before the COVID-19 outbreak. Methods This is a cross-sectional study with a representative sample of 355 HCW from a city in northeastern Brazil. Occupational stress, based on the demand-control model, was measured by the Job Content Questionnaire (JCQ), and depressive symptoms were evaluated by the Patient Health Questionnaire (PHQ-9). Poisson regressions were used to estimate prevalence ratios (PR) and to analyse associations of interest. Results The prevalence of depressive symptoms (PHQ-9 > 9) was 22.4%. Occupational stress was strongly associated with the outcome. In the crude analyses, the prevalence of depression symptoms among workers eposed to high job strain was 3.54 (95% CI: 1.60-6.90) times that of those with low strain. After adjustment for sex, age and income, the prevalence ratio remained highly significant (PR=3.34;95%CI: 1.80-6.18). Conclusions Occupational stress was a strong risk factor for depressive symptoms in a pre-pandemic scenario. The prevalence of depressive symptoms is expected to increase during the pandemic. Assessing occupational stress and depression during follow-up over the next few years may elucidate the impact of the pandemic on work processes and on HCWs mental health.
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Purpose This study aims to develop a risk prioritization process using failure mode and effect analysis (FMEA) in association with composition of probabilistic preferences (CPP) and weighting the risk analysis criteria. It seeks to develop decision-making considering the fast response necessary to achieve project objectives in complex scenarios, such as the pandemic of COrona VIrus Disease 19 (COVID-19). Design/methodology/approach After identifying the risks, the prioritization process was applied to a project in the oil and gas area, in which a focus group assessed these risks. This evaluation took place employing traditional FMEA, FMEA with CPP by axes considering four points of view and FMEA with CPP by weighted sum with the use of a multicriteria method to weight the criteria. These approaches were compared to understand their differences and benefits, with a flow chart being developed, consolidating the procedure. Findings The methodologies that showed the greatest benefits were FMEA with CPP by axes PO (progressive-optimistic) and by weighted sum. Essentially, this was mainly related to the interrelationship between risks and to the importance of prioritization. Originality/value This procedure can consider company's views on what is critical and the interrelationship between risks. It provides a clear segmentation of what should and should not be prioritized. It was also developed in a practical case, showing a possible alternative to support fast responses in decision-making.